1 tablet contains :
Active substance :
Captopril 25 mg.
magnesium stearic acid.
ACE inhibitor. Reduces the formation of angiotensin II from angiotensin I. A decrease in the content of angiotensin II leads to a direct decrease in the release of aldosterone.
At the same time, OPSS, blood pressure, post- and preload on the heart decrease. Expands arteries more than veins. It causes a decrease in the degradation of bradykinin (one of the effects of ACE) and an increase in the synthesis of Pg. The antihypertensive effect does not depend on the plasma renin activity, a decrease in blood pressure is noted at normal and even reduced hormone concentration, which is due to the effect on the tissue renin-angiotensin systems.
Strengthens coronary and renal blood flow. With prolonged use, it reduces the severity of hypertrophy of the myocardium and the walls of resistive arteries. Improves blood supply to the ischemic myocardium. Reduces platelet aggregation. It helps to reduce the Na + content in patients with CHF. At doses of 50 mg / day, it exhibits angioprotective properties against the vessels of the microvasculature and allows to slow down the progression of chronic renal failure in diabetic nephroangiopathy.
A decrease in blood pressure, in contrast to direct vasodilators (hydralazine, minoxidil, etc.) is not accompanied by reflex tachycardia and leads to a decrease in myocardial oxygen demand.
In case of heart failure, an adequate dose does not affect the value of blood pressure. The maximum decrease in blood pressure after oral administration is observed after 60-90 minutes. The duration of the hypotensive effect is dose-dependent and reaches optimal values within a few weeks. degradation of br
- Arterial hypertension (including renovascular).
- Chronic heart failure (as part of combination therapy).
- Quincke's edema (including a history after the use of ACE inhibitors).
- Severe renal dysfunction.
- Bilateral renal artery stenosis or stenosis of a solitary kidney with progressive azotemia.
- Condition after kidney transplantation.
- Primary hyperaldosteronism.
- Stenosis of the aortic opening.
- Mitral stenosis.
- The presence of two obstacles to the outflow of blood from the left ventricle of the heart.
- Hypersensitivity to captopril and other ACE inhibitors.
- Severe liver dysfunction.
- Arterial hypotension.
- Cardiogenic shock.
- Children under 18 years of age.
From the CVS: tachycardia, marked decrease in blood pressure, orthostatic hypotension, peripheral edema.
From the nervous system: dizziness, headache, ataxia, paresthesia, drowsiness, blurred vision.
From the urinary system: impaired renal function.
From the side of hematopoiesis: neutropenia, anemia, thrombocytopenia, agranulocytosis.
Allergic reactions: angioedema of the extremities, face, lips, mucous membranes, tongue, pharynx and larynx, as well as the small intestine (very rare).
On the part of the digestive system: violation of taste, dryness of the oral mucosa, stomatitis, abdominal pain, diarrhea, increased activity of "hepatic" transaminases, hyperbilirubinemia, hepatitis.
On the part of the respiratory system: "dry" cough that passes after discontinuation of the drug, bronchospasm, pulmonary edema.
Laboratory indicators: hyperkalemia, hyponatremia, proteinuria, increased urea nitrogen, hypercreatininemia, acidosis, the appearance of antinuclear antibodies in the blood.
Cases of hypoglycemia have been reported in patients with diabetes mellitus who took insulin and oral hypoglycemic drugs.
Diuretics and vasodilators (for example, minoxidil) potentiate the hypotensive effect of Captopril. With the combined use of Captopril with indomethacin (and, possibly, with other non-steroidal anti-inflammatory drugs), a decrease in the hypotensive effect may be observed.
The antihypertensive effect of Captopril may be delayed when administered to patients receiving clonidine. Simultaneous use with potassium-sparing diuretics or potassium preparations can lead to hyperkalemia. With the simultaneous use of lithium salts, an increase in the concentration of lithium in the blood serum is possible.
The use of captopril in patients taking allopurinol or procainamide increases the risk of neutropenia and / or Stevens-Johnson syndrome. The use of captopril in patients taking immunosuppressive drugs (for example, cyclophosfacin or azathioprine) increases the risk of developing hematological disorders.
How to take, course of administration and dosage
Captopril is prescribed one hour before meals. The dosage regimen is set individually. With arterial hypertension, the drug is prescribed at an initial dose of 25 mg 2 times a day.
If necessary, the dose is gradually increased (with an interval of 2-4 weeks) until the optimal effect is achieved. For mild to moderate arterial hypertension, the usual maintenance dose is 25 mg 2 times a day; The maximum dose is 50 mg 2 times a day. In severe arterial hypertension, the maximum dose is 50 mg 3 times a day. The maximum daily dose is 150 mg. For the treatment of chronic heart failure, Captopril is prescribed in cases where the use of diuretics does not provide an adequate effect.
The average maintenance dose is 25 mg 2-3 times a day. In the future, if necessary, the dose is gradually increased (with an interval of at least 2 weeks). The maximum dose is 150 mg per day. Patients with impaired renal function with a moderate degree of impaired renal function (creatinine clearance of at least 30 ml / min / 1.73 m 2) Captopril can be prescribed at a dose of 75-100 mg / day.
With a more pronounced degree of renal dysfunction (creatinine clearance less than 30 ml / min / 1.73 m 2), the initial dose should be no more than 12.5-25 mg / day; in the future, if necessary, at sufficiently long intervals, the dose of Captopril is gradually increased, but a lower than usual daily dose of the drug is used.
Symptoms: severe arterial hypotension, up to collapse, myocardial infarction, acute cerebrovascular accident, thromboembolic complications.
Treatment: lay the patient down with raised lower limbs; measures aimed at restoring blood pressure (increasing the volume of circulating blood, including intravenous infusion of isotonic sodium chloride solution), symptomatic therapy. The use of hemodialysis is possible; peritoneal hemodialysis - ineffective.
Before starting, and also regularly during treatment with Captopril, kidney function should be monitored. In chronic heart failure, the drug is used subject to careful medical supervision.
Captopril is prescribed with extreme caution to patients with diffuse connective tissue diseases or systemic vasculitis; patients receiving immunosuppressive drugs, especially in the presence of impaired renal function (risk of developing serious infections that do not respond to antibiotic therapy). In such cases, the peripheral blood picture should be monitored before the application of Captopril, every 2 weeks during the first 3 months of therapy and periodically in the subsequent period of treatment.
The drug is used with caution against the background of treatment with allopurinol or procainamide, as well as against the background of treatment with immunosuppressants (including azathioprine, cyclophosphamide), especially in patients with impaired renal function. The likelihood of developing arterial hypotension during treatment can be reduced if, 4-7 days before starting treatment with Captopril, the use of diuretics is stopped or their dose is significantly reduced.
In case of symptomatic arterial hypotension after taking Captopril, the patient should take a horizontal position with raised legs. In the case of severe arterial hypotension, a positive effect is observed with the intravenous administration of isotonic sodium chloride solution.
In the event of the development of angioedema, the drug is canceled and careful medical supervision is carried out. If edema is localized on the face, special treatment is usually not required (antihistamines can be used to reduce the severity of symptoms); in the event that the edema spreads to the tongue, pharynx or larynx and there is a threat of airway obstruction, adrenaline should be injected subcutaneously (0.5 ml at a dilution of 1: 1000) immediately.
Use with caution in patients with a history of kidney disease, as the risk of proteinuria increases. In such cases, during the first 9 months of treatment with Captopril, the amount of protein in the urine should be monitored monthly.
If the level of protein in the urine exceeds 1 g / day, it is necessary to decide on the advisability of further use of the drug. Captopril is prescribed with caution in patients with renal artery stenosis. there is a risk of developing renal dysfunction; in the case of an increase in the level of urea or creatinine in the blood, it may be necessary to reduce the dose of Captopril or discontinue the drug.